Protecting policyholders through better fraud analysis

Fraud continues to be a challenge in the insurance industry. Left unchecked, fraud can compromise operations and undermine a company’s competitive advantage as costs get passed on to customers, driving up premiums.

There are two main types of fraud: occasional fraud committed by an individual and organized fraud perpetrated by sophisticated crime rings. The latter is often difficult to detect, because criminals look for the path of least resistance and have figured out ways to use existing processes to hide their activities. This is why many insurance companies are turning to claims analytics to spot fraud early – and deter future criminal activity before it happens.

We more than doubled our fraud savings by identifying fraudsters before claims payments were made.

Heracles Daskalopoulos
Deputy General Manager

That’s why Ethniki Insurance – the largest insurer in Greece – turned to SAS. Headquartered in Athens, Ethniki Insurance offers auto, home, life, health and disability ­­insurance. With SAS, the company can target suspicious claims more confidently while processing legitimate claims faster. This is leading to increased customer satisfaction by providing prompt service while keeping costs low.

Fighting fraud through analytics

“While insurance fraud is encountered worldwide, it’s an even bigger issue in Greece, where fraud has grown due to the social and economic crisis in the country,” says Heracles Daskalopoulos, Deputy General Manager at Ethniki Insurance. “So, it was imperative to find a solution that would help us combat fraud, maintain competitive advantage and ultimately protect our policyholders.”

SAS Fraud Framework for Insurance gives Ethniki Insurance a cross-channel view of its customers. With this more expansive view, claims agents can identify suspicious claims with more confidence – and the company spends less effort pursuing false positives. Additionally, SAS can look into vast amounts of data to detect previously unknown schemes and spot linked entities and crime rings to stem larger losses.

All of this leads to a more immediate method of fraud detection and remediation. Real-time claims scoring allows Ethniki Insurance to flag suspicious claims before a payment goes out. And because the company is detecting fraud earlier in the cycle, criminals are discouraged from attempting fraudulent activities, resulting in fewer attempts.

“By having a greater degree of control over payouts, any organized networks that came to our attention in claims have ceased causing new damage and concerns for Ethniki Insurance,” Daskalopoulos says.

SAS Fraud Framework also examines how fraud evolves over time. This information can be used to predict different future scenarios that the insurer can act on – and be ready for the next wave of fraudsters.

Safeguarding the business and its customers

In the first 14 months of using SAS Fraud Framework for Insurance, the impact on the insurer’s combined ratio was very clear. “We more than doubled our fraud savings by identifying fraudsters before claims payments were made,” Daskalopoulos says.

In addition to detecting more fraud and preventing false payouts, investigators have become more targeted in their approach. As a result, business costs have gone down as investigators are no longer chasing a number of false positives.

And Ethniki Insurance isn’t the only one benefiting from enhanced fraud detection. The company’s customers are seeing improvements, too. “Customer service and customer loyalty have improved as the system now allows for primary fraud control so we can effectively fast-track genuine claims for faster payouts,” Daskalopoulos says.

And high customer satisfaction can help Ethniki Insurance continue to grow its client base and market share.

“The benefits we’ve gained with SAS have already exceeded the cost of investment,” Daskalopoulos says. “We now have a holistic strategy to our fraud management approach. We’re able to evaluate things differently and more thoroughly than before, and it’s given us the momentum to modernize our operations.”

The results illustrated in this article are specific to the particular situations, business models, data input, and computing environments described herein. Each SAS customer’s experience is unique based on business and technical variables and all statements must be considered non-typical. Actual savings, results, and performance characteristics will vary depending on individual customer configurations and conditions. SAS does not guarantee or represent that every customer will achieve similar results. The only warranties for SAS products and services are those that are set forth in the express warranty statements in the written agreement for such products and services. Nothing herein should be construed as constituting an additional warranty. Customers have shared their successes with SAS as part of an agreed-upon contractual exchange or project success summarization following a successful implementation of SAS software. Brand and product names are trademarks of their respective companies.